Friday, March 23, 2007

More Free Market Bullshit

This is how it is working out for kids & adults. I will say that it is difficult to have much sympathy for the docs who make $182,186 a year. & I know that pediatrics & all of its permutations is the lowest paid of the specialties. Family medicine is even worse - $178,366 a year. Still, not a bad year's wage. Again, however, this is the result of the market. Why go into family medicine for its paltry wage when you can make $470,000 as a cardiac surgeon, or $424,992 as an interventionist radiologist (that's a bit of an oxymoron, eh?), or $417,106 as a sports medicine surgeon? This is another chapter in the Why I Hate Capitalism rant.


Craig Lowery said...

Free market, my ass. There isn't a snowball's chance in hell that these doctors would be making that kind of money were it not for INSURANCE PLANS AND SOCIALIZED MEDICINE! When I was a kid, doctors made house calls, and the rates were reasonable. Now, thanks to the aforementioned, and our beloved attorneys (whose existence and activities result in doctors paying astronomical rates for insurance), it costs $150 for a 10 minute office visit or a bandaid at the emergency room. And please don't tell me they make all that money or that they "deserve" it because they're so "smart". The median IQ of medical students is 114, which is 22 points below mine (I'm a stone mason). Add to that the fact that a lot of them work more than 16 hours a day, with a loss of 10 points per hour after hour 16. You'd probably get better care from a veterinarian.

Anonymous said...

Mr. Lowery’s comment begged for a reply. To begin with, I know of no country with a system of socialized medicine in which doctors’ salaries are as high as those in the United States. Next, I am not aware of the study that concluded the average IQ of U.S. medical students was 114—I have seen results from small studies in the 1950s and 1960s with averages in the 120 to 130s. Regardless, IQ is not a validated measure of the professional aptitude of a doctor. Finally, I agree that working long, continuous shifts can lead to serious medical errors as eloquently demonstrated in two randomized-controlled studies published in the New England Journal of Medicine last year. Unfortunately, last month I worked 30 hour shifts every three days because the American College of Postgraduate Medical Education continues to endorse these limits (which are actually an improvement of resident work hours several years ago). Of course, I would still like to think that I provided better care than a veterinarian.

Below is an excerpt from Uwe Reinhardt, Gerard Anderson, and Peter Hussey's Health Affairs article published in 2002 on medical spending and physicians’ salaries. While several years old, it still offers a succinct, relevant overview of a complicated topic.

“Although the United States now has relatively fewer physicians per 1,000 population than the OECD median, its total national spending on physicians as a percentage of GDP is double the OECD median (2.9 percent in 1999, compared with an OECD median of 1.3 percent). U.S. physician spending peaked in 1991–1992 at 3.0 percent after steadily rising from 1.7 percent in 1980. Since 1992 spending has more or less hovered around 3 percent. OECD median spending has been mostly f lat over the entire period, hovering between 1.1 and 1.4 percent of total spending. As a dollar amount, U.S. per capita spending for physician services was the highest in the OECD in 1999: $988, compared with an OECD median of $342. Physician services accounted for 22.7 percent of total U.S. health spending in 1999, compared with 15.2 percent in the median OECD country.

Physicians’ incomes are much higher in the United States than they are in other OECD countries. In 1996, the most recent year for which data are available for multiple countries, the average U.S. physician income was $199,000. The comparable OECD median physician income was $70,324. The ratio of the average income of U.S. physicians to average employee compensation for the United States as a whole was about 5.5. Germany’s was the next highest, at only 3.4; Canada, 3.2; Australia, 2.2; Switzerland, 2.1; France, 1.9; Sweden, 1.5; and the United Kingdom, 1.4.

One can think of several reasons why physician compensation in the United States is relatively more generous than elsewhere. First, physicians in most other nations face a powerful single buyer (monopsony) for health services. As the McKinsey Global Institute and Mark Pauly have shown, market power (or regulation) translates into relatively lower prices for health services, including the services of physicians.28 Second, U.S. physicians must make a larger financial investment in their education than their counter parts in many other countries do; they must recover the debt they incur as part of the educational process. Third, the incomes of highly skilled health care workers—notably physicians—are determined partly with reference to the incomes that equally able and skilled professionals can earn elsewhere in the economy. Because the U.S. distribution of earned income for all occupations is wider than it is in most other OECD countries, the relatively high incomes offered skilled professionals in the United States may well have served to pull up the incomes of American physicians relative to the incomes of their peers abroad.”

Finally, Medicare has recently revised their resource-based relative-value scale for 2007 compensation. Medicare will increase the physician payment rate for family practice and general internal medicine by 5% while holding the rate for general surgery and decreasing the rate for radiology by 5%. I see it as a step, albeit a small one, in the right direction.

-Luke, M.D.

coldH2O said...

Great comment. & I really appreciate the note on IQ. Intelligence tests, in general, are lousy indicators of a creature's ability. Any creature. & as we are discovering, no link, I can't find it right now, other apes are apparently showing the beginning of morality, or at least, ethics. I, of course, have believed that for a long time. But the results of that study indicate that facial expressions are one indicator of an ethical standard. Cool.